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� Pw �i �� 7- a33 / <br /> Applica�ion Por ����� <br /> � PUBLIC WORKS PERMIT °a1e_-- G��-7 !� <br /> PUBUC WORKS DEPART�dENT Pubtic Works Permit M / ( � / O <br /> 3200 Cedar Street <br /> Eveiett,WA 98201 259-8810 Building Permit N .___—_ <br /> TYPE OR PRINT ONLY Pu6tic Works Fee S_ �(_� <br /> U r rr � 7� G� —l�.�J�. S,t, t(i•rr ff �p �UO 3 3 7-'U J o2�/� <br /> Owner Mailing Address City Zip Phone <br /> �, „ �,�� 3�� y- �v��� s �- rw��� ��� .�3 �- 0 ;� �5� <br /> Applicant f���—�— MailingAddress City Zip Phone <br /> DescribeProposedWork �i��i F�_1—.�rr°� ���jr �� S�G�PwFL" ' W <br /> .� / <br /> U h � �b�vr `� � <br /> — 07-'�'S-971G:4?AhS � <br /> . --���-�2 <br /> PROJECTADDRESS(ifknown) �(� C� __Jy ��(iP. �, /`` �Tf{Ffi` b4`JO M <br /> �ttach four(4)copies ot plans for proposed work-Draw to scale and note ihe following it applicahle: i.-H�t: �ll <br /> •Pwperty Lines •Outline and dimensions ot all existing and proposed sirucWres on�he lot •Existing and propos�d Qltli�il5'� O <br /> •Centedinz ol sUeet •Indicate NoAh •Show any proposed grading changes •Show m�asurements � <br /> DO NOT WRI?E BELOW THIS LINE � <br /> P[RMIT CONDITIONS: <br /> 1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. O 'I <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � i <br /> �. I � �� I p � �OGZ'{� dY! '�r.v� �' d-� lv� O n �y . � <br /> .S �� s�+ !� C�-n s:o� cmn-�a / a sc��1-c�� (�y � O <br /> /' �l a <br /> 7�V J/Z (�OY�S i N S� �1'` �� 't'7G��.-- i rl G��I� <br /> �✓ �" vto� ��M ��C� � �i�! '� �NCG � S�tw � Vi?Q.�e�. <br /> U <br /> —� ACKNOWLEDGEMENT UF CONDI i IONS <br /> The undersigned owner/applicant hereby agrees to hold and save hartnless <br /> L��� 7���� the City ol Everett from any and all claims for damages,costs,ezpenses,or <br /> /`�` � causes of action that may arise because o(installation and maintenance of <br /> Approvedfo�Construction Date Iheimprovementorothenigh�-of-wayuseheretoappliedforandfuriheragrees <br /> � �� �/I to remove same upon nntice from the Ciry and to replace public property <br /> �: �/ <!y CI�,�w,� V � _ Z��5 damaged ihereby. <br /> /l� l7L6 Y� <br /> FINAL INSPECTION �3�� �� �� <br /> Approved as Constructed � —a`} � �f 7 <br /> Signature of Aoplic t Date <br /> WORK AUTHORIZED�Y THIS PERMIT MUST BE STARTED WITHIN 7c,DAYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLETION.iHl�.PERMIT MAY BE CANCELLED BY THE C1iY UPON.4NY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />